Achilles tendon pain when running: what to note before an assessment

Pain at the back of the heel or ankle during a run does not tell you its cause on its own. If it returns, changes the way you run or persists afterwards, note how it develops rather than looking for a universal “Achilles protocol”. Those details can help a professional consider different explanations and discuss an appropriate way forward.

Sudden pain with a snapping sensation, followed by marked weakness or difficulty walking or rising onto your toes, needs prompt medical assessment. Do not try to “test” the tendon by going for another run in that situation.

What information is most useful to record?

You do not need a complicated spreadsheet. A few notes after a run, or over the following days, may be enough:

• Onset: when did you first notice the pain? Did it develop gradually or after a specific event?
• Location: is it near the attachment at the heel, higher along the tendon or elsewhere around the ankle? Location alone cannot establish a diagnosis.
• Timing: is it present with the first steps in the morning, at the start of a run, during or after it, or the next day? Does walking or climbing stairs also bother you?
• Recent activity: have you changed your distance, speed, hill work, jumping, footwear or the frequency of training? Record changes without assuming that any one of them is the cause.
• Daily impact: what have you stopped doing or begun to avoid? What would you like to get back to?

Morning stiffness and activity-related pain are often described in Achilles tendinopathy, but they do not prove that diagnosis. The painful area and clinical examination matter too: pain in the middle of the tendon and pain where it attaches to the heel are not assessed in precisely the same way. Other conditions can also cause pain nearby. An assessment is an opportunity to avoid treating every case as the same problem.

Do you have to stop running completely?

There is no single answer from a distance. Carrying on unchanged while symptoms clearly worsen is not a useful default; nor is several weeks of complete rest a rule for everyone. After assessment, you might discuss temporarily adjusting activity and, if tendinopathy is diagnosed, a progressive loading approach. The nature and location of the pain, your current capacity and your goals all shape that discussion.

Do not turn a pain-scale number found online into automatic permission to run. A number on its own does not show what happens the next day or whether another diagnosis needs to be ruled out. If walking becomes difficult, symptoms worsen markedly or you are uncertain after a sudden event, seek medical advice instead of following a standard programme.

To put the symptom in the context of your activity, our pages on returning to running and returning to trail running with elevation offer different questions to bring to an assessment. Neither page determines what your tendon can tolerate on its own.

What can a physiotherapy assessment clarify?

An assessment brings together your account and an examination suited to the situation. It can help identify what provokes the symptoms, what you can currently do and whether another professional opinion is needed. It cannot promise a recovery date or a return to your previous training volume at the first appointment.

If you run regularly, a conversation with a sports physiotherapist with a focus on running can start with your training history as well as your symptoms. To discuss the stages of returning to activity, a physiotherapist working in sports rehabilitation may also help. The approach depends on the assessment; care for this problem is not limited to these two practitioners.

If you have them, bring notes on recent training, reports from any previous tests and your questions. For example: “What possible causes are you considering?”, “What activity can I maintain while we clarify the problem?”, and “Which changes should make us adjust the plan?” A useful plan is one you understand and can revisit, not a promise to be running again after a fixed number of weeks.

Read more about sports physiotherapy and, if you are preparing for a first visit, our first-appointment guide.

Further reading

• American Physical Therapy Association / Academy of Orthopaedic Physical Therapy, 2024 clinical practice guideline for midportion Achilles tendinopathy (a specific scope, not guidance for every cause of heel pain).
• Mersey Care NHS: Achilles tendinopathy, symptoms, assessment, care and warning signs.

Updated 23 September 2026.